Dr Nicole Ryan

Dr Nicole Ryan

Research Associate

School of Medicine and Public Health

Career Summary

Biography

Dr Ryan is currently a Project Manager for the development of a Certificate in Clinical Teaching and Supervision - General Practice funded by the Valley to Coast Charitable Trust. The certificate has been developed in both online and face to face formats to support GPs in their role as educators in the Hunter New England area, with plans to widen the geographical region to include Central Coast and Manning next year. The main duties of Dr Ryan’s role is to monitor, track and report on the status of the project deliverables to ensure time, cost and quality metrics are in line with approved project timeline. This includes responsibility for organising the project team meeting schedule, drafting meeting agendas and minutes and ensuring tasks/actions as identified through these meetings are met; working with project collaborators particularly in relation to advertising and delivering of the certificate presentations; assisting the Chief Investigator with budget and organising resources required to assist with project deliverables, logistical organisation for delivery of the certificate and, liaising with teaching facilitators/ personnel working on the project. Dr Ryan is also a Y1 problem based learning (PBL) Tutor a role that requires high quality teaching and research support to the Bachelor of Medical Science and Doctor of Medicine (Joint Medical Program). Both of these appointments are within the University of Newcastle School of Medicine and Public Health. 

Recently Dr Ryan held the position of Post-Doctoral Researcher in the Centre for Brain and Mental Health Research at The University of Newcastle, Hunter Medical Research Institute where her projects primarily addressed tobacco smoking in pregnant Indigenous women. Within the team supervised by Prof Gould Nicole’s primary responsibilities were to provide research leadership including oversight of the SISTAQUIT (SQ) Project and SQ Team. Dr Ryan was instrumental in ensuring research projects were of a high standard, completed on time, and effected change based on evidence-based medicine. Dr Ryan has completed a number of systematic reviews and meta-analysis in her past research fields of expertise. Dr Ryan is a much diversified researcher with a suite of research skills that can transferred between disciplines. This is also evident in her previous appointments.

From 2014 to early 2018 Dr Ryan was apart time NHMRC Post-Doctoral Research Fellow in the Clinical Toxicology Research Group at The University of Newcastle. Primary responsibilities of this role included investigating the effects of snake and spider envenoming and their treatment; investigating pharmaceutical treatments for neuropathic pain conditions and; investigating the clinical effects of drugs in overdose.

Dr Ryan has also held a part-time post-doctorate position (2011 to 2014) in the Priority Research Centre for Asthma and Respiratory Disease at UON where she coordinated placebo-controlled RCTs for the treatment of refractory chronic cough. Dr Ryan completed her PhD in Medicine during her 10 year position within the UON PRC. This research led to an interest in the mechanisms and treatment of neuropathic pain conditions. Dr Ryan’s toxicology research has allowed the investigation of other conditions that exhibit neuropathic mechanisms.

Dr Ryan’s respiratory and toxicology clinical research have been translated into clinical practice and guidelines: 2016 American Chest Physician Guidelines; Poisons Information Centre advice line and hospital ‘Discharge Plan’ for serum sickness.

Prior to Dr Ryan’s research career she worked as a Process Engineer at BHP Minerals and earlier as an Industrial Chemist at RZM Mines. These roles involves a thorough understanding on project management, quality control and the necessity to ensure company KPIs and customer expectations were met. Nicole has also delivered lectures and tutorials in all areas of chemistry to students undertaking TAFE Diplomas. 

Dr Ryan has been a UON FHEAM PhD Confirmation Chair, ECR NHMRC Project Grants Observer (2017), NHMRC Project Grant External Assessor (2015) and represented UON ECRs at the Science Pathways 2016: Future Leaders Forum at the UNSW. Prior to Dr Ryan’s NHMRC ECR Fellowship (2014-2018) she held a NHMRC CCRE PhD scholarship and PhD support grant from HMRI to complete her research thesis into Laryngeal Dysfunction in Chronic Cough. Dr Ryan was an invited panel member and adviser at the SMPH Thesis by Publication Workshops and was one of the first UON PhD candidates to complete her thesis by publication. For this thesis Dr Ryan was awarded the Faculty of Health & Medicine Research Higher Degree Excellence Award in 2012. 




Qualifications

  • PhD (Medicine), University of Newcastle
  • Bachelor of Science, University of Newcastle

Keywords

  • Aboriginal and Torres Strait Islander Health
  • Evidence based medicine
  • Medical Education, Teaching
  • Medication Safety and Effectiveness
  • Refractory Chronic Cough
  • Smoking cessation care
  • Translational Research

Fields of Research

Code Description Percentage
111799 Public Health and Health Services not elsewhere classified 100

Professional Experience

UON Appointment

Title Organisation / Department
Associate Lecturer University of Newcastle
School of Medicine and Public Health
Australia
Associate Lecturer Priority Research Centre (PRC) for Healthy Lungs | The University of Newcastle
School of Medicine and Public Health
Australia
Associate Lecturer University of Newcastle
School of Medicine and Public Health
Australia
Casual Academic University of Newcastle
School of Medicine and Public Health
Australia
Casual Academic Priority Research Centre (PRC) for Healthy Lungs | The University of Newcastle
School of Medicine and Public Health
Australia
Casual Academic University of Newcastle
School of Medicine and Public Health
Australia

Academic appointment

Dates Title Organisation / Department
1/05/2014 -  NHMRC Early Career Research Fellow

NHMRC - Early Career Fellowships (Formerly Postdoctoral Training Fellowships)

University of Newcastle
Clinical Toxicology Research Group
Australia
1/10/2010 - 1/06/2013 Research Officer University of Newcastle
School of Medicine and Public Health
Australia
1/12/2005 - 1/10/2010 Research PhD Candidate University of Newcastle
School of Medicine and Public Health
Australia

Membership

Dates Title Organisation / Department
15/09/2015 - 18/10/2017 ASMR Hunter Region Committee Convener

ASMR Hunter Region Committee Convenor

Australian Society for Medical Research (ASMR)
Australia
1/01/2014 - 30/06/2016 Membership - ASMR

Australian Society for Medical Research Committee Member, 2015 Satellite Scientific Meeting Convenor.

Australian Society for Medical Research (ASMR)
Australia

Awards

Research Award

Year Award
2012 HMRI Early Career Travel Award
Unknown
2012 Faculty of Health Research Higher Degree Excellence Award
Unknown
2011 HMRI Pulse Education Prize
Unknown
2008 Finalist 10 of the Best Research Showcase
Unknown

Invitations

Speaker

Year Title / Rationale
2012 Gabapentin for refractory chronic cough: A randomised controlled trial
Organisation: Thoracic Society of Australia and New Zealand Description: CICADA Cough Symposium Invited Speaker

Teaching

Code Course Role Duration
MEDI1101B Year 1 JMP MD PBL Tutorials
Faculty of Health and Medicine, University of Newcastle
JMP MD Phase 1 PBL Tutor 17/07/2018 - 31/12/2018
MEDI2101 Clinical Sciences, Scholarship and Practice 2
Faculty of Health and Medicine, University of Newcastle
JMP MD Year 2 Tutor 1/03/2018 - 30/06/2018
Edit

Publications

For publications that are currently unpublished or in-press, details are shown in italics.

Highlighted Publications

Year Citation Altmetrics Link
2009 Ryan NM, Gibson PG, 'Characterization of laryngeal dysfunction in chronic persistent cough', Laryngoscope, 119 640-645 (2009) [C1]
DOI 10.1002/lary.20114
Citations Scopus - 22Web of Science - 19
Co-authors Peter Gibson
2012 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial', The Lancet, 380 1583-1589 (2012) [C1]
DOI 10.1016/S0140-6736(12)60776-4
Citations Scopus - 155Web of Science - 137
Co-authors Peter Gibson
2015 Ryan NM, Isbister GK, 'Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely', Clinical Toxicology, 53 545-550 (2015) [C1]

© 2015 Informa Healthcare USA, Inc. Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose.... [more]

© 2015 Informa Healthcare USA, Inc. Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose. Objective. This study sought to investigate the effects of tramadol overdose, and included evaluation for serotonin toxicity based on the Hunter Serotonin Toxicity Criteria where the seven clinical features of spontaneous clonus, inducible clonus, ocular clonus, agitation, diaphoresis, tremor and hyperreflexia are examined for in all patients taking serotonergic medications; seizures and central nervous system depression. Materials and methods. This was an observational cases series based on a retrospective review of tramadol overdoses (> 400 mg) admitted to a tertiary toxicology unit from November 2000 to June 2013. Demographic details, information on ingestion (dose and co-ingestants), clinical effects, complications (seizures, serotonin toxicity and cardiovascular effects) and intensive care unit (ICU) admission were extracted from a clinical database. Results. There were 71 cases of tramadol overdose (median age: 41 years, range: 17-69 years; and median ingested dose: 1000 mg, interquartile range [IQR]: 800-2000 mg). Seizures were dose related and occurred in 8 patients, one of them co-ingested a benzodiazepine compared with 16 patients without seizures. There were no cases of serotonin toxicity meeting the Hunter Serotonin Toxicity Criteria. Tachycardia occurred in 27 and mild hypertension occurred in 32. The Glasgow Coma Score was < 15 in 29 and < 9 in 5 patients; three co-ingested tricyclic antidepressants and two tramadol alone (3000 mg and 900 mg). Respiratory depression occurred in 13, median dose: 2500 (IQR: 1600-3000) mg which was significantly different (p = 0.003) to patients without respiratory depression, median dose: 1000 (IQR: 750-1475) mg. Eight patients were admitted to ICU, five due to co-ingestant toxicity and three for respiratory depression. Discussion. Tramadol overdose was associated with a significant risk of seizures and respiratory depression in more severe cases, both which appear to be related to the ingested dose. There were no cases of serotonin toxicity, while opioid-like effects and adrenergic effects were prominent. Conclusion. Tramadol overdose is associated with seizures and respiratory depression, but is unlikely to cause serotonin toxicity.

DOI 10.3109/15563650.2015.1036279
Citations Scopus - 28Web of Science - 22
Co-authors Geoffrey Isbister
2016 Ryan NM, Kearney RT, Brown SGA, Isbister GK, 'Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22)', Clinical Toxicology, 54 27-33 (2016) [C1]

© 2015 Taylor &amp; Francis. Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sic... [more]

© 2015 Taylor & Francis. Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness but the incidence and characteristics are poorly defined. Objective: To investigate the incidence and clinical features of serum sickness following the administration of Australian snake antivenoms. Materials and methods: This was a prospective cohort study of patients recruited to the Australian Snakebite Project who received snake antivenom from November 2012 to March 2014. Demographics, clinical information, laboratory tests and antivenom treatment were recorded prospectively. Patients administered antivenom were followed up at 7-10 days and 6 weeks post-antivenom. The primary outcome was the proportion with serum sickness, pre-defined as three or more of: fever, erythematous rash/urticaria, myalgia/arthralgia, headache, malaise, nausea/vomiting 5-20 days post-antivenom. Results: During the 16-month period, 138 patients received antivenom. 23 were not followed up (unable to contact, tourist, child, bee sting) and 6 died in hospital. Of 109 patients followed up, the commonest reason for antivenom was venom induced consumption coagulopathy in 77 patients. An acute systemic hypersensitivity reaction occurred post-antivenom in 25 (23%) and 8 (7%) were severe with hypotension. Serum sickness occurred in 32/109 (29%) patients, including 15/37 (41%) given tiger snake, 6/15 (40%) given polyvalent and 4/23 (17%) given brown snake antivenom. There was no association between the volume of antivenom and serum sickness, p = 0.18. The commonest effects were lethargy, headache, muscle/joint aches and fever. Discussion: The incidence of serum sickness after snake antivenom in Australia was higher than earlier investigations which failed to define symptoms or follow-up patients, but similar to more recent studies of antivenoms in the United States. Conclusion: Serum sickness is common with Australian snake antivenom but does not appear to be predictable based on the volume of antivenom administered.

DOI 10.3109/15563650.2015.1101771
Citations Scopus - 7Web of Science - 4
Co-authors Geoffrey Isbister

Journal article (25 outputs)

Year Citation Altmetrics Link
2018 Ryan NM, Vertigan AE, Birring SS, 'An update and systematic review on drug therapies for the treatment of refractory chronic cough.', Expert opinion on pharmacotherapy, 19 687-711 (2018) [C1]
DOI 10.1080/14656566.2018.1462795
Citations Scopus - 2Web of Science - 1
2018 Cairns R, Schaffer AL, Ryan N, Pearson SA, Buckley NA, 'Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings', Addiction, (2018)

© 2018 Society for the Study of Addiction Background and aims: Pregabalin is a gamma-aminobutyric acid (GABA) analogue, used to treat neuropathic pain and epilepsy. Pregabalin was... [more]

© 2018 Society for the Study of Addiction Background and aims: Pregabalin is a gamma-aminobutyric acid (GABA) analogue, used to treat neuropathic pain and epilepsy. Pregabalin was registered in Australia in 2005, and subsidized publically in 2013. We aimed to describe Australian patterns of pregabalin use and intentional poisoning, and identify people potentially at high risk of misuse. Design and setting: Population-based retrospective cohort study of dispensings in the 10% sample of Australian Pharmaceutical Benefits Scheme (July 2012¿February 2017); intentional poisoning calls to New South Wales Poisons Information Centre (NSWPIC) (2004¿2016); intentional poisonings in two Australian toxicology service databases; and poisoning fatalities in NSW coronial records (2005¿2016). Participants: A total of 122 572 people dispensed pregabalin, people with intentional pregabalin overdoses managed by NSWPIC and the toxicology services and pregabalin-associated deaths referred to the NSW coroner. Measurements: Trends in dispensing, poisoning, death; demographics and patient characteristics, proportion of users at high risk of misuse (latent class analysis, LCA) and characteristics of high-risk users. Findings: Pregabalin dispensing increased by 73 424 per year [95% confidence interval (CI)¿=¿61726¿85 121 P¿<¿0.001] between 2013 and 2016. NSWPIC received 1158 reports of intentional pregabalin poisonings, with a 53.8% increase per year, 2005¿2016 (95% CI¿=¿44.0¿64.2%, P¿<¿0.001). We identified 88 pregabalin-associated deaths, 57.8% yearly increase (95% CI¿=¿30.0¿91.6%, P¿<¿0.001). Patients overdosing on pregabalin commonly co-ingested opioids, benzodiazepines and illicit drugs, and had high rates of psychiatric and substance use comorbidities; 14.7% of pregabalin users were classed by the LCA as at high risk of misuse, and were more likely to be younger, male, co-prescribed benzodiazepines or opioids, have more individual prescribers and higher pregabalin strengths dispensed. Conclusions: There has been a dramatic increase in pregabalin use, poisonings and deaths in Australia since it became subsidized publicly in 2013. One in seven Australians dispensed pregabalin appears to be at high risk of misuse.

DOI 10.1111/add.14412
2018 Page CB, Ryan NM, Isbister GK, 'The safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity', Clinical Toxicology, 56 389-396 (2018) [C1]

© 2017 Informa UK Limited, trading as Taylor &amp; Francis Group. Context: High-dose insulin euglycaemia (HIE) is recommended in the management of toxin-induced cardiac toxicity... [more]

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Context: High-dose insulin euglycaemia (HIE) is recommended in the management of toxin-induced cardiac toxicity, with increasing insulin doses now being used. We aimed to investigate the safety of HIE in toxin-induced cardiac toxicity. Methods: This was a retrospective review of cases from two clinical toxicology units. Demographics, toxin(s) ingested, clinical effects, investigations (serum glucose, electrolytes), treatments (insulin, glucose, electrolyte replacement), length of stay (LOS) and outcomes were extracted from the patients¿ medical records. Associations between insulin and glucose/electrolyte homeostasis were explored by comparing insulin administration and glucose or electrolyte concentrations and replacement. Results: There were 22 patients (12 females), median age 57 years (15¿88 years) treated with HIE. There were 12 beta-blocker, six calcium channel blocker and three combined beta-blocker and calcium channel blocker ingestions. A total of 19 patients had a systolic blood pressure <80mmHg and 18 patients required inotropes in addition to HIE. There were three deaths. Despite glucose and electrolyte replacement, 16 patients (73%) developed hypoglycaemia (Reference range [RR] < 3.5 mmol/L or <63 mg/dl). In 7 patients, hypoglycaemia was mild (2.5¿3.4 mmol/L or 45¿62 mg/dl) and in nine was severe (<2.5 mmol/L or <45 mg/dl). There were no neurological effects from hypoglycaemia. A total of 18 patients (82%) developed hypokalaemia (<3.5 mEq/L). In 16 patients, this was mild (2.5¿3.4 mEq/L). There were no cardiac arrhythmias associated with this hypokalaemia. There was no apparent association between insulin dosing and severity of hypoglycaemia or hypokalaemia, or in glucose or potassium replacement. Median insulin loading dose was 80U (range 50¿125 U) and the median maximum insulin infusion rate was 150 U/h (range 38¿1500 U/h). Median glucose infusions rates were 37.5g/h (range 4¿75g/h). There was no apparent association between insulin and glucose administration. Glucose was administered for a median of 18h after ceasing insulin. The duration of glucose administration after ceasing insulin increased with the rate and total insulin administered during HIE. Discussion: Despite the benefits of HIE in toxin-induced cardiac toxicity, it caused significant disruption to glucose and electrolyte homeostasis, although there were no apparent complications from this. There was no association by comparing the amount of insulin administered on adverse effects or glucose administered, suggesting higher doses of insulin are associated with no more adverse effects.

DOI 10.1080/15563650.2017.1391391
Citations Scopus - 1Web of Science - 1
Co-authors Geoffrey Isbister
2017 Ryan NM, Buckley NA, Graudins A, 'Treatments for latrodectism¿a systematic review on their clinical effectiveness', Toxins, 9 1-29 (2017) [C1]
DOI 10.3390/toxins9040148
Citations Scopus - 3
2017 Isbister GK, Heppell SP, Page CB, Ryan NM, 'Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity', Clinical Toxicology, 55 187-192 (2017) [C1]

© 2017 Informa UK Limited, trading as Taylor &amp; Francis Group. Context: There are limited reports of adult clonidine overdose. We aimed to describe the clinical effects and t... [more]

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Context: There are limited reports of adult clonidine overdose. We aimed to describe the clinical effects and treatment of clonidine overdose in adults. Methods: This was a retrospective review of a prospective cohort of poisoned patients who took clonidine overdoses (>200 µg). Demographic information, clinical effects, treatment, complications (central nervous system and cardiovascular effects) and length of stay (LOS) were extracted from a clinical database or medical records. Results: From 133 admissions for clonidine poisoning (1988¿2015), no medical record was available in 14 and 11 took staggered ingestions. Of 108 acute clonidine overdoses (median age 27 years; 14¿65 years; 68 females), 40 were clonidine alone ingestions and 68 were clonidine with co-ingestants. Median dose taken was 2100 µg (interquartile range [IQR]: 400¿15,000 µg). Median LOS was 21h (IQR: 14¿35 h) and there were no deaths. Glasgow coma score [GCS] <15 occurred in 73/108 (68%), and more patients taking co-ingestants (8/68; 12%) had coma (GCS <9) compared to clonidine alone (2/40; 5%). Miosis occurred in 31/108 (29%) cases. Median minimum HR was 48 bpm (IQR: 40¿57 bpm), similar between clonidine alone and co-ingestant overdoses. There was a significant association between dose and minimum HR for clonidine alone overdoses (p = 0.02). 82/108 (76%) had bradycardia, median onset 2.5 h post-ingestion (IQR: 1.7¿5.5 h) and median duration 20 h (2.5¿83 h), similar for clonidine alone and co-ingestant overdoses. There were no arrhythmias. Three patients ingesting 8000¿12,000 µg developed early hypertension. Median minimum systolic BP was 96 mmHg (IQR: 90¿105 mmHg) and hypotension occurred in 26/108 (24%). 12/108 patients were intubated, but only 2 were clonidine alone cases. Treatments included activated charcoal (24), atropine (8) and naloxone (23). The median total naloxone dose was 2 mg (IQR: 1.2¿2.4 mg), but only one patient given naloxone was documented to respond with partial improvement in GCS. Discussion: Clonidine causes persistent but not life-threatening clinical effects. Most patients develop mild central nervous system depression and bradycardia. Naloxone was not associated with improved outcomes.

DOI 10.1080/15563650.2016.1277234
Citations Scopus - 3Web of Science - 2
Co-authors Geoffrey Isbister
2017 Johnston CI, Ryan NM, O¿Leary MA, Brown SGA, Isbister GK, 'Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy¿Australian Snakebite Project (ASP-25)', Clinical Toxicology, 55 115-122 (2017) [C1]

© 2016 Informa UK Limited, trading as Taylor &amp; Francis Group. Context: Taipans (Oxyuranus spp.) are medically important venomous snakes from Australia and Papua New Guinea. ... [more]

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Context: Taipans (Oxyuranus spp.) are medically important venomous snakes from Australia and Papua New Guinea. The objective of this study was to describe taipan envenoming in Australian and its response to antivenom. Methods: Confirmed taipan bites were recruited from the Australian Snakebite Project. Data were collected prospectively on all snakebites, including patient demographics, bite circumstances, clinical effects, laboratory results, complications and treatment. Blood samples were taken and analysed by venom specific immunoassay to confirm snake species and measure venom concentration pre- and post-antivenom. Results: There were 40 confirmed taipan bites: median age 41 years (2¿85 years), 34 were males and 21 were snake handlers. Systemic envenoming occurred in 33 patients with neurotoxicity (26), complete venom induced consumption coagulopathy (VICC) (16), partial VICC (15), acute kidney injury (13), myotoxicity (11) and thrombocytopenia (7). Venom allergy occurred in seven patients, three of which had no evidence of envenoming and one died. Antivenom was given to 34 patients with a median initial dose of one vial (range 1¿4), and a median total dose of two vials (range 1¿9). A greater total antivenom dose was associated with VICC, neurotoxicity and acute kidney injury. Early antivenom administration was associated with a decreased frequency of neurotoxicity, acute kidney injury, myotoxicity and intubation. There was a shorter median time to discharge of 51 h (19¿432 h) in patients given antivenom <4 h post-bite, compared to 175 h (27¿1104 h) in those given antivenom >4 h. Median peak venom concentration in 25 patients with systemic envenoming and a sample available was 8.4 ng/L (1¿3212 ng/L). No venom was detected in post-antivenom samples, including 20 patients given one vial initially and five patients bitten by inland taipans. Discussion: Australian taipan envenoming is characterised by neurotoxicity, myotoxicity, coagulopathy, acute kidney injury and thrombocytopenia. One vial of antivenom binds all measurable venom and early antivenom was associated with a favourable outcome.

DOI 10.1080/15563650.2016.1250903
Citations Scopus - 6Web of Science - 6
Co-authors Geoffrey Isbister
2017 Johnston CI, Ryan NM, Page CB, Buckley NA, Brown SGA, O Leary MA, Isbister GK, 'The Australian snakebite project, 2005¿2015 (ASP-20)', Medical Journal of Australia, 207 119-125 (2017) [C1]
DOI 10.5694/mja17.00094
Citations Scopus - 6Web of Science - 4
Co-authors Geoffrey Isbister
2016 de Silva HA, Ryan NM, de Silva HJ, 'Adverse reactions to snake antivenom, and their prevention and treatment.', British journal of clinical pharmacology, 81 446-452 (2016) [C1]
DOI 10.1111/bcp.12739
Citations Scopus - 27Web of Science - 23
2016 Vertigan A, Kapela S, Ryan NM, Birring S, McElduff P, Gibson P, 'Pregabalin and speech pathology combination therapy for refractory chronic cough: A randomised controlled trial.', Chest, 149 639-648 (2016) [C1]
DOI 10.1378/chest.15-1271
Citations Scopus - 39Web of Science - 37
Co-authors Patrick Mcelduff, Peter Gibson
2016 Ryan NM, Kearney RT, Brown SGA, Isbister GK, 'Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22)', Clinical Toxicology, 54 27-33 (2016) [C1]

© 2015 Taylor &amp; Francis. Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sic... [more]

© 2015 Taylor & Francis. Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness but the incidence and characteristics are poorly defined. Objective: To investigate the incidence and clinical features of serum sickness following the administration of Australian snake antivenoms. Materials and methods: This was a prospective cohort study of patients recruited to the Australian Snakebite Project who received snake antivenom from November 2012 to March 2014. Demographics, clinical information, laboratory tests and antivenom treatment were recorded prospectively. Patients administered antivenom were followed up at 7-10 days and 6 weeks post-antivenom. The primary outcome was the proportion with serum sickness, pre-defined as three or more of: fever, erythematous rash/urticaria, myalgia/arthralgia, headache, malaise, nausea/vomiting 5-20 days post-antivenom. Results: During the 16-month period, 138 patients received antivenom. 23 were not followed up (unable to contact, tourist, child, bee sting) and 6 died in hospital. Of 109 patients followed up, the commonest reason for antivenom was venom induced consumption coagulopathy in 77 patients. An acute systemic hypersensitivity reaction occurred post-antivenom in 25 (23%) and 8 (7%) were severe with hypotension. Serum sickness occurred in 32/109 (29%) patients, including 15/37 (41%) given tiger snake, 6/15 (40%) given polyvalent and 4/23 (17%) given brown snake antivenom. There was no association between the volume of antivenom and serum sickness, p = 0.18. The commonest effects were lethargy, headache, muscle/joint aches and fever. Discussion: The incidence of serum sickness after snake antivenom in Australia was higher than earlier investigations which failed to define symptoms or follow-up patients, but similar to more recent studies of antivenoms in the United States. Conclusion: Serum sickness is common with Australian snake antivenom but does not appear to be predictable based on the volume of antivenom administered.

DOI 10.3109/15563650.2015.1101771
Citations Scopus - 7Web of Science - 4
Co-authors Geoffrey Isbister
2015 Ryan NM, Isbister GK, 'Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely', Clinical Toxicology, 53 545-550 (2015) [C1]

© 2015 Informa Healthcare USA, Inc. Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose.... [more]

© 2015 Informa Healthcare USA, Inc. Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose. Objective. This study sought to investigate the effects of tramadol overdose, and included evaluation for serotonin toxicity based on the Hunter Serotonin Toxicity Criteria where the seven clinical features of spontaneous clonus, inducible clonus, ocular clonus, agitation, diaphoresis, tremor and hyperreflexia are examined for in all patients taking serotonergic medications; seizures and central nervous system depression. Materials and methods. This was an observational cases series based on a retrospective review of tramadol overdoses (> 400 mg) admitted to a tertiary toxicology unit from November 2000 to June 2013. Demographic details, information on ingestion (dose and co-ingestants), clinical effects, complications (seizures, serotonin toxicity and cardiovascular effects) and intensive care unit (ICU) admission were extracted from a clinical database. Results. There were 71 cases of tramadol overdose (median age: 41 years, range: 17-69 years; and median ingested dose: 1000 mg, interquartile range [IQR]: 800-2000 mg). Seizures were dose related and occurred in 8 patients, one of them co-ingested a benzodiazepine compared with 16 patients without seizures. There were no cases of serotonin toxicity meeting the Hunter Serotonin Toxicity Criteria. Tachycardia occurred in 27 and mild hypertension occurred in 32. The Glasgow Coma Score was < 15 in 29 and < 9 in 5 patients; three co-ingested tricyclic antidepressants and two tramadol alone (3000 mg and 900 mg). Respiratory depression occurred in 13, median dose: 2500 (IQR: 1600-3000) mg which was significantly different (p = 0.003) to patients without respiratory depression, median dose: 1000 (IQR: 750-1475) mg. Eight patients were admitted to ICU, five due to co-ingestant toxicity and three for respiratory depression. Discussion. Tramadol overdose was associated with a significant risk of seizures and respiratory depression in more severe cases, both which appear to be related to the ingested dose. There were no cases of serotonin toxicity, while opioid-like effects and adrenergic effects were prominent. Conclusion. Tramadol overdose is associated with seizures and respiratory depression, but is unlikely to cause serotonin toxicity.

DOI 10.3109/15563650.2015.1036279
Citations Scopus - 28Web of Science - 22
Co-authors Geoffrey Isbister
2015 Ryan NM, Downes MA, Isbister GK, 'Clinical features of serum sickness after Australian snake antivenom', Toxicon, 108 181-183 (2015) [C3]

© 2015 Elsevier Ltd. All rights reserved. Serum sickness is a delayed immune reaction in which the immune system responds to a protein in antiserum as a potentially harmful substa... [more]

© 2015 Elsevier Ltd. All rights reserved. Serum sickness is a delayed immune reaction in which the immune system responds to a protein in antiserum as a potentially harmful substance and mounts an IgG-mediated antibody response. A 32 year-old female patient had systemic envenoming following a bite by a red-bellied black snake (Pseudechis porphyriacus). She was treated with Tiger snake antivenom and recovered over 24 h and did not develop myotoxicity. She then presented with local pain, itching and swelling, which was partially treated with antihistamines. Eleven days after the bite she presented again with symptoms of worsening serum sickness including rash on the upper legs, joint and muscle pain in arms, ankles and knees, and nausea. The patient was prescribed five days of prednisone 50 mg/day, antihistamine 10 mg/day and analgesia 1000 mg/day and improved over 2 days. She had no further problems on follow up at 4 months. This case highlights that serum sickness can cause significant effects after the treatment of snake envenoming. It develops 5-14 days after antivenom administration and has characteristic clinical and laboratory features. Severe cases of serum sickness can result in morbidity but it appears to respond well to corticosteroid treatment.

DOI 10.1016/j.toxicon.2015.10.012
Citations Scopus - 5Web of Science - 4
Co-authors Geoffrey Isbister
2014 Simpson JL, Baines KJ, Ryan N, Gibson PG, 'Neutrophilic asthma is characterised by increased rhinosinusitis with sleep disturbance and GERD', Asian Pacific Journal of Allergy and Immunology, 32 66-74 (2014) [C1]

Background: Asthma is a heterogeneous inflammatory disease and eosinophilic, noneosinophilic and neutrophilic forms are recognised. While clinically similar to eosinophilic asthma... [more]

Background: Asthma is a heterogeneous inflammatory disease and eosinophilic, noneosinophilic and neutrophilic forms are recognised. While clinically similar to eosinophilic asthma, patients with non-eosinophilic asthma have different responses to treatment and little is known about the triggers of symptoms and inflammation. Objective: This study sought to characterise asthma control, exacerbation frequency and potential triggers of non-eosinophilic and specifically neutrophilic asthma such as infection, gastroesophageal reflux disease, and rhinosinusitis. Methods: Adults with asthma (n=65; doctor's diagnosis plus demonstrated response to bronchodilator and/or airways hyperresponsiveness to hypertonic saline) were recruited from the Respiratory and Sleep Medicine Ambulatory Care Service at John Hunter Hospital, NSW, Australia. Questionnaires were administered to assess gastroesophageal reflux disease, rhinosinusitis and asthma control. A sputum induction was performed and sputum was processed for assessment of inflammatory cells, infection, and lipid laden macrophages (Oil Red O). Results: Participants with neutrophilic asthma (n=11, 23%) had a higher frequency of primary care doctor visits for asthma exacerbations and a high prevalence (>70%) of chest infections in the previous 12 months. There was also an increased prevalence of rhinosinusitis (64%) and increased symptoms of gastroesophageal reflux disease compared to those with eosinophilic asthma. Conclusions: The clinical pattern of neutrophilic asthma is different from paucigranulocytic and eosinophilic asthma with evidence of abnormal upper airways responses. Specific and targeted treatment of these airway problems may assist in the control and management of neutrophilic asthma.

DOI 10.12932/AP0322.32.1.2014
Citations Scopus - 16Web of Science - 11
Co-authors Katherine Baines, Jodie Simpson, Peter Gibson
2014 Gibson PG, Simpson JL, Ryan NM, Vertigan AE, 'Mechanisms of cough', CURRENT OPINION IN ALLERGY AND CLINICAL IMMUNOLOGY, 14 55-61 (2014) [C1]
DOI 10.1097/ACI.0000000000000027
Citations Scopus - 13Web of Science - 12
Co-authors Jodie Simpson, Peter Gibson
2014 Ryan NM, 'A review on the efficacy and safety of gabapentin in the treatment of chronic cough.', Expert Opinion on Pharmacotherapy, 16 1-11 (2014) [C1]
DOI 10.1517/14656566.2015.981524
Citations Scopus - 13Web of Science - 12
2014 Ryan NM, Gibson PG, 'Recent additions in the treatment of cough', JOURNAL OF THORACIC DISEASE, 6 S739-S747 (2014) [C1]
DOI 10.3978/j.issn.2072-1439.2014.03.13
Citations Scopus - 5Web of Science - 5
Co-authors Peter Gibson
2014 Ryan NM, Birring SS, Gibson PG, 'Arnold¿s nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy', Journal of Thoracic Disease, 6 S748-S752 (2014) [C3]
DOI 10.3978/j.issn.2072-1439.2014.04.22
Citations Scopus - 9Web of Science - 9
Co-authors Peter Gibson
2013 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough Reply', LANCET, 381 624-625 (2013) [C3]
DOI 10.1016/S0140-6736(13)60340-2
Citations Scopus - 3Web of Science - 3
Co-authors Peter Gibson
2012 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial', The Lancet, 380 1583-1589 (2012) [C1]
DOI 10.1016/S0140-6736(12)60776-4
Citations Scopus - 155Web of Science - 137
Co-authors Peter Gibson
2012 Ryan NM, Vertigan AE, Ferguson JK, Wark PA, Gibson PG, 'Clinical and physiological features of postinfectious chronic cough associated with H1N1 infection', Respiratory Medicine, 106 138-144 (2012) [C1]
DOI 10.1016/j.rmed.2011.10.007
Citations Scopus - 13Web of Science - 11
Co-authors Peter Wark, Peter Gibson, John Ferguson
2011 Gibson PG, Ryan NM, 'Cough pharmacotherapy: Current and future status', Expert Opinion on Pharmacotherapy, 12 1745-1755 (2011) [C1]
Citations Scopus - 21Web of Science - 18
Co-authors Peter Gibson
2010 Ryan NM, Vertigan AE, Bone S, Gibson PG, 'Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough', Cough, 6 1-8 (2010) [C1]
Citations Scopus - 43
Co-authors Peter Gibson
2009 Ryan NM, Vertigan AE, Gibson PG, 'Chronic cough and laryngeal dysfunction improve with specific treatment of cough and paradoxical vocal fold movement', Cough, 5 1-8 (2009) [C1]
DOI 10.1186/1745-9974-5-4
Citations Scopus - 26
Co-authors Peter Gibson
2009 Ryan NM, Gibson PG, 'Characterization of laryngeal dysfunction in chronic persistent cough', Laryngoscope, 119 640-645 (2009) [C1]
DOI 10.1002/lary.20114
Citations Scopus - 22Web of Science - 19
Co-authors Peter Gibson
2008 Ryan NM, Gibson PG, 'Extrathoracic airway hyperresponsiveness as a mechanism of post infectious cough: Case report', Cough, 4 1-4 (2008) [C3]
DOI 10.1186/1745-9974-4-7
Citations Scopus - 10
Co-authors Peter Gibson
Show 22 more journal articles

Conference (17 outputs)

Year Citation Altmetrics Link
2018 Johnston C, Buckley N, Brown S, Ryan NM, Page C, Isbister GK, 'Acute kidney injury in Australian snake envenoming: common, multifactorial and somewhat avoidable (ASP-26)', CLINICAL TOXICOLOGY (2018)
Co-authors Geoffrey Isbister
2016 Page CB, Ryan NM, Isbister GK, 'The use and safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity', Madrid, Spain (2016)
Co-authors Geoffrey Isbister
2016 Isbister GK, Heppell SP, Page CB, Ryan NM, 'Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity', Madrid, Spain (2016)
Co-authors Geoffrey Isbister
2016 Johnston C, Silva A, Siribaddana S, Ryan NM, Maduwage K, Isbister GK, 'Sri Lankan Russell's viper envenoming causes mild myotoxicity.', Madrid, Spain (2016)
Co-authors Geoffrey Isbister
2016 Ryan NM, Page CP, Isbister GK, 'The incidence of pregabalin overdose has increased but clinical effects are primarily associated with the coingestants', Brisbane, QLD (2016)
Co-authors Geoffrey Isbister
2016 Johnston C, Ryan NM, Isbister GK, 'Sea snake envenoming in Australia causes myotoxicity, local effects and non-specific systemic symptoms (ASP-24)', CLINICAL TOXICOLOGY (2016)
Co-authors Geoffrey Isbister
2015 Ryan N, Isbister GK, 'Tramadol overdose is associated with an increased risk of seizure but not serotonin toxicity', CLINICAL TOXICOLOGY (2015) [E3]
Co-authors Geoffrey Isbister
2015 Ryan NM, Brown SGA, Isbister GK, 'Serum sickness after the administration of Australian snake antivenoms', HMRI (2015)
Co-authors Geoffrey Isbister
2014 Ryan NM, Isbister GK, 'Tramadol overdose is associated with an increased risk of seizure and unassociated with serotonin toxicity', TAPNA Conference Program, Newcastle, NSW (2014) [E3]
Co-authors Geoffrey Isbister
2014 Ryan NM, Brown SSGA, Isbister GK, 'Serum sickness after the administration of Australian snake antivenoms', CLINICAL TOXICOLOGY (2014) [E3]
Co-authors Geoffrey Isbister
2014 Ryan NM, Brown SSGA, Isbister GK, 'Serum sickness after the administration of Australian snake antivenoms', CLINICAL TOXICOLOGY (2014) [E3]
Co-authors Geoffrey Isbister
2013 Ryan NM, 'Recent additions in the treatment of cough', J Thorac Dis, Guangzhou (2013) [E3]
2013 Ryan NM, Vertigan AE, Bone SL, Gibson PG, 'Pregabalin and Speech Pathology for Chronic Cough', Journal of Thorac Disease, Guangzhou (2013) [E3]
2013 Simpson JL, Baines KJ, Ryan NM, Gibson PG, 'NEUTROPHILIC ASTHMA IS CHARACTERIZED BY INCREASED GERD AND RHINOSINUSITIS WITH SLEEP DISTURBANCE', RESPIROLOGY (2013) [E3]
Co-authors Katherine Baines, Jodie Simpson, Peter Gibson
2012 Ryan NM, Gibson PG, 'Gabapentin for idiopathic chronic cough: A randomised controlled trial', Lung, New York, NY (2012) [E3]
Co-authors Peter Gibson
2011 Ryan NM, Vertigan AE, Ferguson JK, Wark PA, Gibson PG, 'Investigation and characterization of persistent cough associated with H1N1 2009 influenza', Respirology, Perth, WA (2011) [E3]
Co-authors Peter Gibson, John Ferguson, Peter Wark
2010 Ryan NM, Vertigan AE, Bone S, Gibson PG, 'Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough', Respirology, Brisbane, QLD (2010) [E3]
DOI 10.1186/1745-9974-6-5
Co-authors Peter Gibson
Show 14 more conferences
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Grants and Funding

Summary

Number of grants 12
Total funding $287,554

Click on a grant title below to expand the full details for that specific grant.


20172 grants / $19,107

Development of a 3D In Vitro human cell culture system to investigate the mechanism of sudden collapse following snakebite envenoming$18,052

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Nicole Ryan, Dr Erika Bosio, Ms Abbie Francis
Scheme Program Grant
Role Lead
Funding Start 2017
Funding Finish 2018
GNo G1701192
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

NHMRC Translational Australian Clinical Toxicology (TACT) Program, Training and Travel Support Scheme $1,055

Invited speaker at the Toxicology and Poisons Network Association of Australia 2017 Scientific Conference, Melbourne Australia.

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team

Dr Nicole M Ryan

Scheme Partnership Grant
Role Lead
Funding Start 2017
Funding Finish 2017
GNo
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON N

20163 grants / $36,371

Combination Analgesia for Redback spider Envenoming (CARE) Study- A randomised controlled trial$19,966

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Nicole Ryan, Professor Geoff Isbister, Professor Nicholas Buckley, Professor Andis Graudins, Professor Daniel Fatovich
Scheme Program Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo G1501400
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Research Advantage Early Career Researcher Equipment Grant $13,998

Research Advantage Early Career Researcher Equipment Grant 2016 for ‘Frimed Laboratory Freezer with Alarm’. This freezer is used to store research blood samples related to the CI’s research program including patient samples from the Australian Snakebite Project (ASP), the Australian Toxicology Monitoring Study (ATOM) and the international multi-institutional CRE in Venom and Antivenom Translational Research projects.

Funding body: The University of Newcastle - Research and Innovation Division

Funding body The University of Newcastle - Research and Innovation Division
Scheme Research Advantage Funding
Role Lead
Funding Start 2016
Funding Finish 2016
GNo
Type Of Funding Internal
Category INTE
UON N

NHMRC Translational Australian Clinical Toxicology (TACT) Program, Training and Travel Support Scheme (TTRS).$2,407

NHMRC Translational Australian Clinical Toxicology (TACT) Program, Training and Travel Support Scheme  for attendance and  presentation at the 15th International Scientific Conference of the Asia Pacific Medical Association of Medical Toxicology (APAMT) 2016, Singapore 17‐20 November 2016.

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Scheme Program Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON N

20151 grants / $3,000

Faculty of Health and Medicine Pilot Grant $3,000

2015 Faculty Pilot Grant for Project: Early snake antivenom administration (ESAA) Study.

Funding body: The University of Newcastle

Funding body The University of Newcastle
Scheme Faculty of Health and Medicine Pilot Grant
Role Lead
Funding Start 2015
Funding Finish 2015
GNo
Type Of Funding Internal
Category INTE
UON N

20141 grants / $155,748

Combined Treatment for Chronic Cough$155,748

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Nicole Ryan
Scheme Early Career Fellowships
Role Lead
Funding Start 2014
Funding Finish 2017
GNo G1300679
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20132 grants / $29,810

Pregabalin and Speech Pathology Treatment for Refractory Chronic Cough with Laryngeal Hypersensitivity $23,810

Funding body: John Hunter Hospital Charitable Trust

Funding body John Hunter Hospital Charitable Trust
Project Team Doctor Nicole Ryan, Conjoint Associate Professor Anne Vertigan, Doctor Michael Hayes, Ms Sarah Bone
Scheme Research Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300784
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

HMRI Early Career Travel Award 2012$6,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Nicole Ryan
Scheme Research Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300514
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20121 grants / $4,000

PULSE Education Prize$4,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Nicole Ryan
Scheme PULSE Education Prize
Role Lead
Funding Start 2012
Funding Finish 2013
GNo G1200455
Type Of Funding Scheme excluded from IGS
Category EXCL
UON Y

20091 grants / $20,000

HMRI RHD Support Grant$20,000

RHD Support Grant from the Hunter Medical Research Institute [the Greaves family] for PhD candidacy.

Funding body: Hunter Medical Research Institute (HMRI)

Funding body Hunter Medical Research Institute (HMRI)
Project Team

Nicole M Ryan, Peter G Gibson

Scheme Research Grant
Role Lead
Funding Start 2009
Funding Finish 2009
GNo
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON N

20071 grants / $19,518

Mrs Nicole M Ryan$19,518

Funding body: CCRE in Respiratory and Sleep Medicine

Funding body CCRE in Respiratory and Sleep Medicine
Project Team

Prof Peter G Gibson

Scheme Postgraduate Research Scholarship
Role Investigator
Funding Start 2007
Funding Finish 2007
GNo
Type Of Funding Internal
Category INTE
UON N
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Research Supervision

Number of supervisions

Completed0
Current2

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2015 PhD Snake Envenoming in Australia and Beyond: Investigating Myotoxicity and the Early use of Antivenom PhD (Clinical Pharm), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2015 PhD Antidotes and Treatments in Overdose PhD (Clinical Pharm), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
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Research Projects

ATOM Studies: Pregabalin, Gabapentin Toxicity Project 2015 -

The aim of this project is to investigate the toxic effects and pharmacokinetics of pregabalin and gabapentin in overdose.


Investigating the QT Interval in a Normal Population 2015 -

  The objectives of this study are to:

  1. Investigate the QT interval in a normal population including individual QT variability;
  2. Investigate the relationship between QT and heart rate (RR interval) for individuals in a normal population;
  3. Investigate other factors that many influence the length of the QT interval – age, sex, diurnal variation
  4. Investigate QT hysteresis in a normal population.  Our hypothesis is that about 1 to 3% of the normal population will have an abnormal QT based on the QT nomogram. Little information is known about QT hysteresis in the normal population but previous studies suggest it is on average about 2 minutes.


A randomised controlled trial of early antivenom for red-bellied black snake envenoming 2014 -

The purpose of this project is to investigate the effectiveness and safety of early antivenom administration for the treatment of red-bellied black snake bites/envenoming. Red-bellied black snakebites are the most common in Eastern Australia and are not routinely treated with antivenom because they appear to cause minor effects and there is concern about the risk of allergic reactions to antivenom. However, recent work by the ASP investigators suggests that the early use of antivenom will reduce the chance of people developing muscle damage. This study is a randomised controlled trial of one vial of tiger snake antivenom compared to standard care (placebo) and this will provide good evidence for or against the early administration of antivenom for muscle damage. The study will also investigate whether antivenom neutralises other effects of RBBS envenoming and determine the frequency of allergic reactions, including anaphylaxis, after antivenom use.


Randomised controlled trial of early antivenom administration in Australian snakebite 2015 -

Current standard practice for any snake bite requires laboratory testing to determine if a patient has been envenomed, and coagulation studies are the most important tests. The administration of antivenom is then based on the presence of clinical effects of envenoming and abnormal laboratory investigations. Many of these envenoming effects are irreversible, so once they develop they are unlikely to be reversed by antivenom. This means that, antivenom needs to be given prior to the development of irreversible envenoming syndromes. The aim of this project will be to administer antivenom early – as soon as the patient presents to hospital ‐ without first waiting for laboratory tests or the development of clinical signs of envenoming (except non‐specific symptoms), and/or retrieval to a major hospital for laboratory testing. The objective is to determine if the administration of early antivenom will prevent envenoming effects and therefore significant morbidity or death.


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Dr Nicole Ryan

Positions

Research Associate
UON JMP MD program and Medical Education
School of Medicine and Public Health
Faculty of Health and Medicine

Associate Lecturer
UON JMP MD program and Medical Education
School of Medicine and Public Health
Faculty of Health and Medicine

Casual Academic
UON JMP MD program and Medical Education
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email nicole.ryan@newcastle.edu.au
Phone (02) 4985 4078
Link Twitter

Office

Building Bowman Building
Location Callaghan Campus
University Drive
Callaghan, NSW 2308
Australia
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